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Medicaid Expansion

The Affordable Care Act gives states new opportunities to expand Medicaid. Individuals under 65 years of age with incomes up to 133% of the federal poverty level may be eligible for Medicaid in states that have elected to expand their Medicaid programs. Certain low-income adults without children in those states will be eligible for Medicaid coverage for the first time without need for a waiver.

Key issues for family planning providers in Medicaid expansion states include screening for eligibility and enrollment of newly Medicaid-eligible individuals. Under the Affordable Care Act, states must use a single, streamlined application to apply for coverage through programs including Medicaid and CHIP as well as the Marketplace (described below). Individuals must be able to apply in person, online, by phone or by mail. The law further requires states to use new uniform eligibility standards based on the applicant's modified adjusted gross income (MAGI) to calculate eligibility. These same standards will be used to calculate eligibility for premium tax credits and cost-sharing reduction available through the Marketplaces.

Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment are much simpler and are coordinated with the newly created Health Insurance Marketplaces.

In states that are not implementing the Medicaid expansion in 2014, some people won’t qualify for either Medicaid or lower Marketplace insurance costs. Read more about states not expanding Medicaid here. States may choose to expand Medicaid in the future.

Read more about Medicaid and CHIP eligibility and enrollment.